House Says No to Senate Two-Month 'SGR Fix'

WASHINGTON -- The House of Representatives now appears unlikely to approve the bill passed by the Senate over the weekend that would delay by two months drastic cuts in Medicare payments to physicians.

After initially signaling agreement with the Senate plan, House Speaker John Boehner (R-Ohio) used a Sunday appearance on NBC's "Meet the Press" to announce that the GOP majority in the House opposes the two-month fix, which he said simply kicked the problem down the road.

The Senate voted 89-10 Saturday morning to pass the bill which would, among other things, avert a 27% cut in Medicare payments to doctors -- currently slated to take effect on Jan. 1 through the end of February.

The bill would hold payments to doctors steady for two months, but some House Republicans are saying that two months isn't long enough and that Congress should agree on a one-year solution.

The House is scheduled to vote on the Senate bill Monday evening.

With Jan. 1 less than two weeks away, the Centers for Medicare and Medicaid Services is likely to fall back on strategy used in previous stand-offs with Congress: simply delay processing physician reimbursements in the hope that Congress will act to avert the automatic cut. In the past, CMS has initially held-up processing for 10 days, but in some years it delayed payment for a month or more.

On Saturday, the American Medical Association said that a two-month fix as not good enough, saying that a permanent solution to the problem is called for instead.

The pending 27% reimbursement cut is mandated by the sustainable growth rate (SGR) formula that links Medicare physician reimbursement rates to increases in the gross domestic product (GDP). Because spending on physician services has outpaced increases in the GDP, the formula has called for cuts in reimbursement each year over most of the past decade -- and Congress has always voted to push those cuts down the road.

Before the Senate took its Saturday morning vote, Boehner implied that while he didn't favor making many of the bill's provisions -- including the SGR patch -- last for only two months, he'd support the bill as long as it forced Obama to make a call on the controversial Keystone XL oil pipeline, which the Senate bill did.

"I believe that two months is -- two months is just kicking the can down the road," Boehner said Sunday. "The American people are tired of that. It's time to just stop, do our work, resolve the differences, and extend this for one year."

Boehner suggested that the House and Senate could have a formal conference to resolve the differences between the two bills, but Senate Majority Leader Harry Reid (D-Nev.) issued a statement on Monday afternoon nixing that idea and accusing Boehner of walking away from a deal negotiated by Democratic and Republican leaders.

"I will not re-open negotiations until the House follows through and passes this agreement that was negotiated by Republican leaders, and supported by 90 percent of the Senate," Reid said.

Reid said he's happy to continue negotiations on a year-long extension to the payroll tax holiday and SGR bill, but not until the House passes the two-month measure.

The House of Representatives passed a spending bill earlier in the week that included a provision that would prevent a 27% cut in physician Medicare payments for one full year. That bill contained offsets that Democrats were never realistically going to support and Reid called the bill "dead on arrival" in the Senate.

The AMA criticized Congress for waiting until the last minute to address the doctor pay-cut issue. "Waiting until the last week of the legislative session to address a problem that Congress knew was looming all year is not the way to conduct our nation's business," said AMA president Peter Carmel, MD, in a statement.

"It is time for Congress to act on previous commitments to repeal the failed Medicare physician payment formula," he said. "The 12 temporary patches that Congress has applied have raised the cost of solving the problem by more than 500 percent over the last few years and eroded patients' access to care. A permanent solution is the long overdue, fiscally responsible approach."

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